Vitamin D during lactation – 6,000 IU mom or 400 IU infant (Hollis, Wagner chapter) – Aug 2018

Vitamin D in Pregnancy and Lactation: A New Paradigm

Handbook of Nutrition and Pregnancy pp 71-88 DOI https://doi.org/10.1007/978-3-319-90988-2_4
Bruce W. Hollis, Carol L. Wagner

PDF is available free at Sci-Hub   10.1007/978-3-319-90988-2_4

While much has been written about the importance of vitamin D during the lifespan, its greatest impact appears to be during pregnancy and lactation, affecting not only the mother but her growing fetus and, later, growing infant. Controversy surrounds the daily requirement for vitamin D and what constitutes sufficiency during these critical periods. A growing body of literature supports the importance of vitamin D supplementation during pregnancy to achieve a total circulating 25(OH)D concentration of at least 40 ng/mL, the point at which the conversion of 25(OH)D to 1,25(OH)2D is optimized. This level is associated with a lower risk of comorbidities of pregnancy and better outcomes. During lactation, a maternal daily dose of 6000 IU vitamin D/d is effective and safe at elevating milk vitamin D delivery to the recipient infant in such a manner that those infants do not require an additional vitamin D supplement. These infants also achieve a comparable total circulating 25(OH)D concentration compared to infants supplemented with 400 IU/day. Further, past data suggesting that vitamin D is a teratogenic compound are not well supported in the extant literature. To the contrary, significant amounts of vitamin D are required during pregnancy to protect the mother and fetus and impart genomic imprinting on the fetus to ensure long-term health. With enhanced knowledge about vitamin D’s role as a preprohormone, it is clear that recommendations for supplementation should mirror what is clinically relevant and evidence-based.

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From PDF

Key Points

• The function of vitamin D during pregnancy is diverse, involving genomic alteration that is involved in decreasing birth complications and infant asthma development.
• The vitamin D requirement during pregnancy and lactation has been greatly underestimated.
• Women should take 4000 IU/d vitamin D prior and during pregnancy.
• Lactating mothers should consume 6000 IU/d vitamin D to satisfy her requirement as well as the requirement of her nursing infant.

Obstetrical “Paranoia” with Regard to Vitamin D Administration During Pregnancy
We refer to this type of thinking as “medical lore”; however, in this particular case because it carries forth into current medical care, we view it with serious concern. It happens when medical students are taught something that is based on outdated data that have been carried through to the present. This is absolutely the case with the use of vitamin D during pregnancy. Why is this?
Because of the British experience with idiopathic infantile hypercalcemia attributed to hypervitaminosis D, a terrible inaccurate association occurred that had a profound effect on the potential of vitamin D supplementation, not only during infancy but also during pregnancy. In 1963, Black and Bonham-Carter [24] recognized that elfin facies observed in patients with severe idiopathic infantile hypercalcemia resembled the peculiar facies observed in patients with supravalvular aortic stenosis (SAS) syndrome. Shortly thereafter, Garcia et al. [25] documented the occurrence of idiopathic hypercalcemia in an infant with SAS who also had peripheral pulmonary stenosis, mental retardation, elfin facies, and an elevated blood concentration of vitamin D. This is an interesting observation because in 1964, when the article was published, there were no quantitative means of assessing circulating concentrations of vitamin D. In fact, at that time, it was not even proven that vitamin D was further metabolized within the body. By 1967, vitamin D was viewed by the medical community as the cause of SAS syndrome [26, 27]. As a result of the theory that maternal vitamin D supplementation during pregnancy caused SAS syndrome [28], animal models were developed to show that toxic excesses of vitamin D during pregnancy would result in SAS [29, 30]. In these earlier cases (22), vitamin D had nothing to do with the etiology of SAS. What was described as vitamin D-induced SAS syndrome is now known as Williams Syndrome [31, 32]. Unfortunately, vitamin D intake during pregnancy is still associated with SAS.
Williams Syndrome is a severe genetic affliction related to elastin gene disruption [31] that is caused by deletion of elastin and contiguous genes on chromosome 7 g 11.23. This syndrome is characterized by multiorgan involvement (including SAS), dysmorphic facial features, and a distinctive cognitive profile [32]. Such patients often exhibit abnormal vitamin D metabolism, which makes them susceptible to bouts of idiopathic hypercalcemia [33]. This relationship was suspected as early as 1976 [34]. Subsequently, it was shown that children with Williams Syndrome exhibit an exaggerated response of circulating 25(OH)D to orally administered vitamin D [35]. Thus, the fear of vitamin D-induced SAS is based on studies that are no longer valid yet continue to be cited and feared, and thus impact treatment.

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